Faculty Bibliography

OBJECTIVE:The relationship between physical activity and sleep with inflammatory arthritis (IA) is understudied, and existing research has relied largely on self-report or short-term assessments. The NIH All of Us database provides long-term accelerometry data, enabling more precise estimation of the association between lifestyle behaviors and IA. METHODS:Participants from the All of Us database who shared electronic health record and Fitbit data were included. Daily activity and sleep metrics were compared between individuals with and without IA using multiple linear regression. Cox proportional hazards regression was used to examine the association of activity and sleep patterns with incident IA in a 10-year follow-up period. RESULTS:A total of 23,855 participants were included, 200 of whom had IA. Participants with IA took fewer daily steps (P < 0.001) and had greater sleep variability (P < 0.001) compared to those without IA. 122 individuals had incident IA. Every 1,000 extra daily steps were associated with a 7% lower risk of IA (hazard ratio [HR] 0.93 [95% confidence interval (CI) 0.87-0.99], P = 0.02). Compared to those who walked <5,000 steps daily, those who walked 5,000 to 10,000 steps and 10,000+ steps had a 41% (HR 0.59 [95% CI 0.39-0.91], P = 0.02) and 50% (HR 0.50 [95% CI 0.29-0.86], P = 0.01) reduction in risk of IA. CONCLUSION/CONCLUSIONS:Individuals with IA had reduced step counts and more sleep variability compared to those without IA, highlighting how physical activity and sleep contribute to IA. Additionally, increased daily step count was associated with decreased risk of incident IA, suggesting a possible research intervention for those at high risk of IA.

Anaphylaxis is a rapid-onset, potentially life-threatening systemic allergic reaction that remains a significant clinical concern in pediatric practice. Food allergies are the most common trigger in children, and a substantial proportion of affected patients experience severe reactions. This review provides a practical, evidence-based framework for the diagnosis and management of IgE-mediated allergy in the pediatric setting, emphasizing recognition, treatment, and preparedness. Anaphylaxis is a clinical diagnosis based on established criteria, with age-specific presentations that may complicate recognition, particularly in infants and young children. Epinephrine is the cornerstone of treatment and the only therapy capable of reversing life-threatening respiratory and cardiovascular manifestations. Early epinephrine administration improves outcomes, yet real-world use remains suboptimal due to barriers such as needle aversion, device complexity, and access challenges. Pediatricians play a critical role in identifying at-risk patients, prescribing epinephrine, and reinforcing preparedness through education and individualized action plans across care settings. Integrating evolving therapeutic options with established best practices may help to address persistent gaps in care and improve outcomes for children at risk of anaphylaxis.

IMPORTANCE/UNASSIGNED:The decision to transfuse a patient with myocardial infarction (MI) and anemia at a higher vs lower hemoglobin threshold must consider the potential benefit of reduced risk of 30-day death or MI and the potential risk of heart failure. OBJECTIVES/UNASSIGNED:To estimate bayesian posterior risk differences and posterior probabilities that a liberal vs restrictive transfusion strategy is associated with reduced risk of 30-day death or MI and whether the probabilities exceed predefined thresholds. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:The Myocardial Ischemia and Transfusion (MINT) trial recruited adults from April 26, 2017, to April 14, 2023, who were hospitalized with MI and anemia at 144 sites in 6 countries. Statistical analysis was performed from July 31, 2024, to February 18, 2026. INTERVENTION/UNASSIGNED:The MINT trial randomized participants to a restrictive (transfuse if hemoglobin is <7 to 8 g/dL) or liberal (maintain hemoglobin at >10 g/dL) transfusion strategy. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Bayesian posterior risk differences were estimated for 30-day death or MI and for heart failure using 3 prior beliefs regarding the treatment strategies: noninformative, liberal strategy superiority, or restrictive strategy superiority. RESULTS/UNASSIGNED:The mean (SD) age of the 3504 participants was 72.1 (11.6) years and 1911 (54.5%) were men. Compared with the restrictive strategy, the risk of 30-day death or MI with the liberal strategy was 1.4% (95% credible interval, -0.8% to 3.5%) to 2.4% (95% credible interval, 0.3%-4.6%) lower, depending on prior beliefs. The probability that the liberal strategy was associated with a lower risk of 30-day death or MI ranged from 89.1% to 98.8%, and the probability that a liberal strategy was associated with at least 1 less death or MI per 100 treated was between 62.7% and 90.4%. Conversely, the risk of heart failure with the liberal strategy was 0.2% (95% credible interval, -1.6% to 1.2%) to 0.6% (95% credible interval, -2.0% to 0.8%) higher compared with the restrictive strategy, depending on prior beliefs. The probability that the liberal strategy was associated with a higher risk of heart failure ranged from 60.6% to 80.0%, and the probability that a liberal strategy was associated with at least 1 more heart failure event per 100 treated was between 13.3% and 29.3%. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This post hoc analysis of a randomized clinical trial of patients with MI and anemia suggests that a liberal transfusion strategy was associated with a lower risk of 30-day death or MI, outweighing the increased risk of heart failure. Consistent with guideline recommendations and according to patients' values and clinician risk assessment, a liberal transfusion strategy may be reasonable. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT02981407.

INTRODUCTION/BACKGROUND:Vascularized Composite Allotransplantation (VCA) is a reconstructive technique that restores form and function in patients with severe tissue loss from trauma, burns, tumors, or congenital anomalies. Despite improving clinical outcomes, public understanding and acceptance remain barriers to widespread public acceptance. This systematic review examines global public perceptions of VCA, focusing on demographic, cultural, religious, and educational influences on donation. METHODS:A PRISMA-guided systematic review was conducted in June 2025 across PubMed, Embase, MEDLINE, Scopus, and Web of Science. Eligible studies included original surveys or mixed-methods research involving nonexpert participants who reported willingness to donate to VCA. Excluded were studies limited to experts, discussion articles, reviews, abstracts, or commentaries. RESULTS:Twenty studies met the inclusion criteria, representing 19,023 respondents from 8 countries. Overall, there was a lower pooled willingness to donate facial VCA than hand VCA, with pooled willingness estimates of 47.9% and 54.8%, respectively. In contrast, willingness to receive VCA was higher overall, with pooled willingness estimates of 65.6% for facial transplantation and 72.4% for hand transplantation. Religious differences were evident: Christian and agnostic respondents were generally more willing to donate, whereas Muslim respondents were less willing. Racial differences were also noted, with White respondents more likely to donate. In contrast, Black and Asian respondents were less likely to indicate willingness to donate. CONCLUSIONS:This systematic review provides the first comprehensive synthesis of global survey data on public perceptions of VCA. Nearly half of the respondents reported willingness to donate, with higher acceptance of hand donation than of face donation. Racial, ethnic, and religious factors shape attitudes, underscoring the need for culturally tailored educational strategies to improve donation acceptance.

BACKGROUND/UNASSIGNED:Many overhead athletes, both amateur and professional, experience an increasing number of injuries to the ulnar collateral ligament (UCL) as a result of overuse or trauma. As a result of this increasing frequency, multiple techniques have been developed to reconstruct or repair the UCL with success and faster return to sports (RTS) for athletes who are ideal candidates for a repair. However, a large proportion of UCL tear patients cannot undergo repair due to chronic injury, leading to poor tissue quality, midsubstance tears, or older age, which predispose them to slower healing and a more difficult path to total rehabilitation. The senior author's "hybrid" reconstruction combines a palmaris longus autograft for reconstruction with a repair-style suture brace augmentation that allows for increased load-to-failure strength that parallels the native UCL, while allowing for native anatomic motion of the ligament when ranging the elbow. INDICATIONS/UNASSIGNED:This technique is indicated for patients with a UCL tear confirmed by magnetic resonance imaging, poor to moderate UCL tissue quality, midsubstance tears, and older patients who have a palmaris longus tendon to harvest and persistent ulnar nerve paresthesias. TECHNIQUE DESCRIPTION/UNASSIGNED:This video demonstrates the senior author's technique of harvesting a palmaris autograft, drilling proximal and distal UCL graft passage tunnels, augmenting the graft with an internal suture brace, fixation of the graft, and finally an ulnar nerve transposition to alleviate ulnar nerve paresthesia. RESULTS/UNASSIGNED:Outcomes of retrospective studies demonstrate good to excellent outcomes of UCL hybrid reconstructions with suture brace augmentation and RTS rates of at least 85%. Complication rates are low, with the most common complication being graft failure (14%) and the next most common being temporary ulnar nerve paresthesia. DISCUSSION/CONCLUSION/UNASSIGNED:Overall, this video demonstrates a highly effective technique at restoring native-like biomechanics and function for patients with UCL tears that are too complex to repair. Patients have good to excellent outcomes and RTS rates, although time to RTS may take 12 months or longer. PATIENT CONSENT DISCLOSURE STATEMENT/UNASSIGNED:The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

PURPOSE/OBJECTIVE:This study aimed to examine associations of bisphenol and phthalate exposure with arterial stiffness among women of reproductive age. METHODS:Participants include 637 adult women enrolled in the New York University Children's Health and Environment Study (NYU CHES), a prospective pregnancy cohort. The concentrations of eight bisphenols and 22 phthalate metabolites were quantified in up to three spot urine samples. Primary outcomes included brachial artery distensibility (BrachD) and carotid-femoral pulse wave velocity (cfPWV) as measures of peripheral and central arterial stiffness, respectively, along with blood pressure assessed at repeated study visits up to seven years from exposure measures. Associations between averaged, log2-transformed, creatinine-standardized chemical concentrations and subclinical vascular outcomes of interest were examined using linear mixed-effects models. RESULTS:In covariate-adjusted models, a doubling of bisphenol A was positively associated with BrachD (0.09%/mmHg, 95% confidence interval [CI] = 0.02, 0.16), a doubling of bisphenol S was negatively associated with mean arterial pressure (MAP) (-0.52 mmHg, 95% CI = -0.98, -0.05), a doubling of di(2-ethylhexyl) phthalate (DEHP) metabolites was negatively associated with diastolic blood pressure (DBP) (-0.81 mmHg, 95% CI = -1.38, -0.23) and MAP (-0.83 mmHg, 95% CI = -1.45, -0.21), and a doubling of antiandrogenic phthalate metabolites was associated with 0.62 mmHg lower DBP (95% CI = -1.22, -0.03) and 0.66 mmHg lower MAP (95% CI = -1.30, -0.02). CONCLUSION/CONCLUSIONS:These findings suggest that routine exposure to bisphenols and DEHP may be associated with vasorelaxation, potentially related to these chemicals' estrogenic and/or antiandrogenic effects.

Working memory (WM), the transient storage and manipulation of information, is a cognitive function that can improve with training. Accumulating evidence suggests that sleep, particularly slow oscillations (SOs) that occur during nonrapid eye movement sleep, supports this improvement. Yet, how sleep and SOs in particular relate to neural processes supporting WM remains poorly understood. In this study, we investigated how WM-related neural activity evolves across nocturnal sleep and how these changes relate to neural processing during SOs. Participants performed a WM task during fMRI before and after sleep, with simultaneous EEG-fMRI capturing neural activity during the first 2.5 hr of sleep. Our results showed significant overnight changes in WM-related activity, characterized by reduced recruitment of the dorsal precuneus during WM encoding/maintenance phases and frontal regions during the retrieval phase of WM. In addition, sleep increased item-specific reinstatement in a sensory processing region during WM. This pattern of results suggests a combined influence of sleep on enhancing sensory reinstatement while reducing potential top-down control (i.e., reduced parietal and frontal activity). Critically, SO-related activity was directly linked to overnight activity changes: Stronger SO activation in the premotor cortex and ventromedial pFC predicted greater overnight reductions in WM-related activity, and multivoxel analyses in the ventral attention network revealed a parallel relationship. These findings suggest that SOs play a critical role in WM function by facilitating the reorganization of WM-related processing.

OBJECTIVE:To assess the perceived clinical impact of radiologist staffing shortages across the U.S. and identify potential short- and long-term solutions. METHODS:A 26-question survey on breast imaging staffing shortages was distributed to active Society of Breast Imaging physician members from May 31, 2024, to June 28, 2024. Questions regarding the impact on patient care and radiologist wellbeing, as well as potential solutions, were included. Bivariable analysis (chi-squared) was performed between the survey demographics and survey response questions of interest. RESULTS:Of 226 respondents who felt understaffed in their practice due to an insufficient number of radiologists, the most frequently reported impact on patients was delayed diagnostic imaging (171/226, 75.7%) and procedures (155/226, 68.6%). The most frequently reported impacts on radiologists were increased stress (198/226, 87.6%), working hours (173/226, 76.6%), and burnout (173/226, 76.6%). As a perceived consequence, 56.2% (127/226) of respondents reported colleagues transitioning to part-time and 35.8% (81/226) reported colleagues switching practice types. To mitigate effects of understaffing, the most frequently reported short-term strategy was offering moonlighting (100/226, 44.2%), whereas offering part-time employment was the most frequently reported long-term strategy for retaining (86/226, 38.1%) and recruiting (120/226, 53.1%) radiologists. Over one-third (77/226, 34.1%) of respondents reported using advanced practice providers, most often for procedural support and patient navigation. CONCLUSION/CONCLUSIONS:Understaffed breast radiologists often perceived delays in patient care and increased levels of physician burnout. Moonlighting and part-time opportunities may mitigate these effects in the short and long-term, respectively.